Taking care, that Imaging is well-integrated into the Radiotherapy Process

Ensure, that geometric concepts (frame of reference and related constructs) are well-defined so that radio-therapeutic planning and delivery can rely on precise geometric definitions to ensure safe beam placement

Considering and further developing DICOM Unified Worklist concepts and specifications and make use of those approaches in to the Radiotherapy workflow

Roadmap

The major goal of WG-07 is to enable departmental workflow, improve safety through tighter standard definition, and open DICOM to new technologies and processes in RT. Those goals are closely related to activities of IHE-RO, where profiles are in development to support the same goals.

WG-07 and IHE-RO directions are well-aligned which each other and the clinical community, and there is a close relationship to IHE-RO (for many individuals on a shared membership basis). Further on professional societies (most prominently ASTRO and AAPM) are asking for more electronic process control and safety checks, which require a powerful workflow environment. WG-07 is committed to serve those interests in the area of interoperability it deals with.

The current and future processes in radiotherapy have considerable evolved since the introduction of Radiotherapy object to DICOM in 1997. Further on, new treatment modalities and positioning techniques seek support for interoperability. This led WG-07 to the conclusion, that the current (‘1st Generation’) DICOM object for RT are at their limits and a new generation of DICOM Radiotherapy objects is needed.

Therefore the roadmap of WG-07 for the next years focusses of the introduction of the so-called ‘2nd Generation Radiotherapy objects’ to the DICOM standard.

Specifically the following areas are in focus of WG-07 throughout the next years:

Supplement 147 (Second Generation Radiotherapy)

That supplement is the foundation for 2nd Generation Radiotherapy objects, and adds already various treatment modalities to the Standard

WG-07 concentrates to get this supplement finished first, followed by some other small supplements which will then incrementally add other objects (e.g. Ions and Brachytherapy) to that foundation.

Supplement 160 (Patient Positioning and Workflow)

This supplement covers the workflow of a Radiotherapy Treatment Session across components of different vendors being involved in preparation, patient positioning, treatment delivery and post-treatment review activities.

This supplement makes use of the concepts and definitions in Supplement 147, but maybe used in parts already the context of 1st generation Radiotherapy objects.

The supplement is closely related to IHE-RO Profiles (especially the workflow-related profiles)

Introduction of Brachytherapy therapy object to 2nd Generation along the concepts of Supplement 147

New Development

Companion objects for Treatment Planning, Dose etc.

Approaches to represent local data clusters, which reference all objects relevant to a specific use case.

New Services to improve efficiency and specificity of retrieving data

Reports specific to segmentation and radiotherapy use cases

Short-Term Goals

WG-07 is working to finalize Supplement 147 (Second Generation Radiotherapy) for public comment. The public comment phase ex expected to start in 2014, lasting 6 month.

Work of Supplement 160 should be resumed in conjunction with the IHE-RO Technical Committee subgroup for the DPDW (Discrete Positioning and Delivery Workflow) Profile.

The Brachytherapy and Ion Subgroups will continue to work actively on the agenda described above.

Current Status

Supplement 147 (Second Generation Radiotherapy) is near to completion to be presented to a wider audience in public comment.

Supplement 160 is available in an initial version and work is ongoing.

WG-07 has established 2 subgroups dealing with the specific treatment techniques of Ion Therapy and Brachytherapy. Those subgroups will contribute the 2nd Generation object definitions, but also will take care of some 1st Generation Standard maintenance as needed.

Current Work Items

Supplement 147 (Second Generation Radiotherapy), being developed pursuant to work item 2007-06-B.

Supplement 160 (Patient Positioning and Workflow), being developed pursuant to work item 2011-12-A.

Risks

The agenda of WG-07 has a considerable broad scope. Resources working in Radiotherapy and being DICOM literate are not abundant and are shared with IHE-RO Technical Committee activities.

While important for safe and efficient interoperability in modern radiotherapy, the adoption of second generation will require a certain amount of training and implementation by the vendors and community. WG-07 will have to play a key role in that process.

IHE-RO (IHE in Radiation Oncology) is an active initiative requiring support from DICOM for workflow and other activities. WG-07 needs to progress its work at a rate consistent with IHE-RO goals where possible.

Challenges and Opportunities

Adoption of upcoming second-generation radiotherapy objects represents significant investment by manufacturers. The introduction of electronic workflow (predominantly using Unified Worklist and Procedure Step) is an established goal, but also includes with some challenges in respect to coverage and quality of implementation.

Although IHE-RO is also promoting their uptake, synchronization of implementations across the industry represents a challenge. The potential payoff is however high: many existing technologies require the new objects, and workflow implementation across the industry could lead to very significant gains in productivity. Recent radiation safety initiatives will also encourage use of Supplement 147 objects and the follow-up supplement to address some of these concerns. Last not least modern radiotherapy cannot be efficiently handled with the 1st generation objects anymore, and current implementations increasingly use Band-Aids to support today’s workflows.

Relationships to Other Standards

RT objects make use of IEC-61217 for some certain classes of treatment machines, where C-Arm isocentric geometry is suited. ICRU concepts for dosimetry as also referred to. IEC/TR 62266 (“Medical Electrical Equipment – Guidelines for Implementation of DICOM in Radiotherapy”), and IEC 62274 (“Safety of Radiotherapy Record and Verify Systems”) have also been published. IEC has started to recognize DICOM as a mean of electronic data transfer, and WG-07 will continue to be involved in review of IEC standards where necessary, especially where IEC Standards could eventually have overlapping definitions on electronic data representations which are covered by DICOM already.

In the scope of IHE-RO and IHE in general, the boundaries between DICOM and HL7 will be increasingly a topic of consideration while developing the new set of objects. WG-07 will assist in the process to identify the appropriateness of protocols (esp. DICOM versus HL7) for the various use cases.

Proceedings in the definition of Patient Dose Recording Regulations will be monitored by WG-07 for the imaging procedures in the context of radiotherapy treatment delivery.